“Some have decried President Trump for issuing tariffs recently, based on some nations’ failure to stem synthetic drugs gushing like a burst pipe across America’s borders.”

These are the words of Cartwright Weiland, Senior Official for the 

Bureau of International Narcotics and Law Enforcement Affairs

 of the United States of America (USA). Weiland used his platform to spread disinformation and blame at the 

 (CND) back in March of this year—seemingly proud of his performance, his 

 were shared verbatim on the U.S. Department of State website. We’re going to stay focused on the above excerpt, the burst pipe of synthetic drugs, but let’s pull one more quote just to set the scene for this auspicious speech:

“Briefly on onto America’s southern neighbor. Oh, Mexico. Yesterday there was a big party in the Zocalo. Lots of music, mucha fiesta. Perhaps everyone was cheering the end of abrazos no balazos.”

Weiland doesn’t deserve any further mention; his words are emblematic of a new tone set by the Trump Administration. His vividly painted portrait of synthetic drugs pouring into the USA, the allegations levied against Canada, and the ensuing threats of 

 are much worthier of our attention. Indeed, these accusations are in bad faith, easily disproven, and paint Canada as a negligent actor on the international stage – it is demonstrable that Canada’s contribution to the American illicit fentanyl supply represents a 

 of the amount seized at USA land borders. And yet, in the face of a moral panic driven by disinformation, Canada has capitulated to the USA, first by appointing a Fentanyl Czar and pouring over a billion dollars towards enhanced border security, and now by introducing the 

By offering policy ‘solutions’ to a non-existent problem, Canada has accepted the dominant narrative that they are somehow complicit in significantly contributing to the American drug poisoning emergency. Moreover, by responding to these accusations by bolstering interdiction and stepping on human rights, the Canadian Government is accepting the problematization of the fatal drug poisoning emergency as driven by external actors, rather than focusing on domestic structural determinants. Only weeks ago, over 

 demanded the complete withdrawal of the 

“Bill C-2 is anti-privacy, anti-rights, and anti-Canadian. It solves border problems that don’t exist; and breaks rights that do.”

The forever emergency of toxic drugs and toxic drug policies

All of this backsliding is transpiring during Canada and the USA’s prolonged, and persisting, public health emergencies of toxic unregulated drugs. As in the case of most moral panics, there are inarguable truths that must be acknowledged, including the fact that both nations remain in the grips of a devastating crisis. According to the 

, an average of 21 Canadians die every day at the hands of the toxic, illicit drug supply. That’s a preventable death every hour and eight minutes. Similarly, the 

 (NCHS) reported “in 2023, 105,007 drug overdose deaths occurred” in the USA.

With the aim of interdiction being drug seizures, policymakers should consider the unintended impacts on communities. Whilst decades of drug war mentalities have led Canadians to believe drug seizures translate to less drugs on the streets and therefore, less harm, a growing body of evidence suggests otherwise. A 

 that included 14 peer-reviewed studies, dating back to 2013, focused on the impact of law enforcement drug seizures on fatal and non-fatal overdose rates in the surrounding area and found that “fentanyl-related seizure measures are positively associated with overdose mortality outcomes”. One 

“within 7, 14, and 21 days, opioid-related law enforcement drug seizures were significantly associated with increased spatiotemporal clustering of overdoses within radii of 100, 250, and 500 meters”

Mobilising expertise and growing influence

How do you fight back when evidence is abandoned, lives are sacrificed on the altar of international cooperation, and the decision-makers are virtually unreachable? Well, you change your vantage point. You find a new arena. You make new allies. Effective advocacy for a better future – a future that prioritizes human rights, bodily autonomy, evidence and the expertise of those most affected by policy – is of utmost importance to the 

 (HRNA). In the wake of the USA’s unjustified tariff war and Canada’s newfound policy of appeasement, we decided to apply for consultative status at the United Nations 

When the going gets tough, the tough get creative. Applying for consultative status is free and poses the potential to allow the HRNA to take our advocacy to the international stage. By leveraging our expertise in harm reduction and public health, the HRNA can support the UN’s global health, human rights, and sustainable development goals. At a time when the CND is demonstrating a willingness to 

, engagement is a low-risk venture with high reward potential. We seek to encourage others to take this step because there are many experts and vital perspectives that deserve a seat at the table. Simultaneously, we recognise that this process may be overwhelming, and so we have agreed to share our experience as we navigate the ECOSOC consultative status application.

Truly, the biggest challenge in the ECOSOC application process is the way it makes you feel vulnerable. There are both supporters and detractors of harm reduction at the adjudication table and clicking ‘submit’ on your application elicits a degree of anxiety. Aside from discomfort, the application is straightforward. Most of the questions from the application are likely easily pulled from your organisation’s website, bylaws, and financial statements. We know it may take a year, or two, or three, before our application is approved. But we also know, even with past instances of 

, that we will be successful in the end. One thing is for certain. We cannot rely on the so-called expertise of our elected leaders in matters relating to international drug policy, because they’re not basing their policies on expertise, or evidence, or ethics.

Same fight, new arena: Mobilising expertise in times of regression

, the International Narcotics Control Board (INCB) once again draws attention to a longstanding failure of the UN drug control regime: the persistent lack of, and stark disparities in access to affordable morphine. In doing so, the Report underscores the importance of opioids for severe pain management in palliative care and harm reduction, and of psychotropics to treat mental health conditions, including in situations of conflict.

According to the INCB, opioid consumption remains higher in Western and Central Europe, North America and Oceania – while consumption continues to be inadequate in East and South-East Asia, Central America and the Caribbean, South Asia and Africa. North America continues to have the highest per capita consumption of opioids (United States 27,709 S-DDDpmpd) and Africa has the lowest (Namibia, 92 S-DDDpmpd).

The largest producers of the world’s morphine include France, Iran, India, Norway, the UK, Japan, and Australia. Most of the morphine manufactured in the world is utilised to produce codeine (211,202 kg) and other substances. As a result, only 33,547 kg are used directly for palliative care, mostly in high-income countries, with only a fraction (4,750 kg) being consumed for that purpose in low- and middle-income countries. This falls drastically short of the INCB’s estimate that at least 43,000 kg of morphine would be needed annually to reach minimally adequate consumption levels in all regions. This is the amount required to raise the availability to 200 S-DDDpmpd in all regions with low consumption

The INCB Report urges opioid-producing countries to increase the manufacture of morphine preparations for pain management and palliative care, and to make morphine more broadly available and more affordable, in particular in low- and medium-income countries.

The Report also highlights the chronic under-provision of opioid agonist therapy (OAT) for people dependent on opioids – pointing out that only 10% of people in need have access to OAT with methadone and buprenorphine, mostly in the Americas and Europe. The largest consumer country (24,6 tons) remains the United States, accounting for half of the global consumption. In a notable shift from previous years, 

the Board’s Report for 2024 explicitly encourages countries to develop and expand services, including the use of controlled medicines such as methadone and buprenorphine for OAT – a reflection of the INCB’s evolving stance on harm reduction.

Various psychotropic substances controlled under the 1971 Convention – such as alprazolam (the most consumed psychotropic in the world), diazepam, lorazepam, midazolam and phenobarbital, which are all included on the WHO Model List of Essential Medicines – are used for the treatment of ADHD, anxiety, narcolepsy, epilepsy and sleeping disorders. 

It is estimated by WHO that 301 million people were suffering from anxiety globally in 2019, a number that has increased by 25% since the pandemic. And yet, once again, access is highly unequal.

 In 2023, the consumption of alprazolam in the United States stood at 9.89 S-DDDpmpd, while it didn’t exceed 1 S-DDDpmpd in Africa and East and South-East Asia. In this context, 

the Board recommends better training of healthcare providers to ensure more rational prescribing, particularly in low- and middle-income countries.

With the increased instability and exacerbation of conflicts in various parts of the world over the past few years, it is unsurprising that the Board devotes a special section of its Annual Report to humanitarian emergencies caused by armed conflict. In doing so, the Board reaffirms that the safe passage of medical supplies is a critical aspect of the Geneva Conventions, and that the international drug control conventions allow for the expedited movement of controlled medicines during emergencies, even in the absence of import authorisations or estimates.

This Report reflects a notable shift by the INCB over the past decade towards a recognition of the importance of ensuring better access to controlled medicines for palliative care, pain relief and harm reduction.

 These changes have been gradually made thanks to the evolving composition of the Board and increased engagement with civil society, which have encouraged more progressive views about the complexity of the drug situation. Nonetheless, the recent US funding cuts on foreign aid and health cooperation are now adding an extra challenge for low- and middle-income countries to implement the INCB’s recommendations.

The persistent challenge in ensuring access to controlled medicines for an overwhelming majority of the world’s population also raises serious concerns over the ability of the current UN drug control regime to fulfil its core mandate

 – the protection of the ‘health and welfare of humankind’. As the UN system is undergoing a severe financial and liquidity crisis and the Secretary-General is embarking on an overall reform of the UN, the global drug control regime is also facing criticism. In March, a 

 tabled by Colombia and supported by a cross-regional coalition of Member States was adopted at CND to create a panel of 19 independent experts appointed by the CND, the UN Secretary-General, the INCB and the WHO, to rethink the implementation of the drug control conventions. 

The panel is an opportunity to propose concrete changes prioritising health and human rights and thus close the gap in access to and availability of controlled medicines for palliative care and harm reduction.

¹ The INCB considers consumption under 200 S-DDDpmpd to be inadequate. S-DDDpmpd: defined daily doses for statistical purposes per million inhabitants per day.

INCB recommends increased morphine production for palliative care

This feature zooms into the drug deaths crisis in British Columbia, now the leading cause of death for people aged 10 to 59 in the province. Declared a public health emergency in 2016, this crisis has pushed over 16,000 people into premature death and continues to worsen due to a toxic and unpredictable drug supply.

The short documentary outlines the origins and evolution of the crisis, the challenges with current responses, and difficulties in moving toward decriminalised frameworks.

Advocates, health and legal experts, and bereaved parents highlight the urgent need for a safe supply, expanded access to treatment and policies that are grounded in public health rather than punishment.

Canada: Everything you need to know about B.C.'s toxic drug crisis

On March 28, President Donald Trump announced Sara Carter as his pick for “drug czar.” Carter, who will need to be confirmed by the Senate, has a background as a journalist and Fox News contributor, with no direct drug policy or public health experience.

“From Afghanistan to our Border, Sara’s relentless pursuit of Justice, especially in tackling the Fentanyl and Opioid Crisis, has exposed terrorists, drug lords, and sex traffickers,” Trump said in a statement. “As our next Drug Czar, Sara will lead the charge to protect our Nation, and save our children from the scourge of drugs.”

Carter’s website describes her as a “national and international award-winning investigative reporter whose stories have ranged from national security, terrorism, immigration and front line coverage of the wars in Afghanistan and Iraq.” Besides her most recent role contributing to FOX News, she has written for outlets including the Washington Times, the Washington Examiner and USA Today. Her past reporting on the US-Mexico border has focused on undocumented immigration, secret tunnels and trafficking routes, and the involvement of Mexican officials in the drug trade.

“Drug czar” is the informal name for the director of the White House Office of National Drug Control Policy (ONDCP). According to the White House, the office “leads and coordinates the nation’s drug policy so that it improves the health and lives of the American people,” managing the National Drug Control Strategy and budget. The ONDCP works with 19 federal agencies and a $44 billion budget, “as part of a whole-of-government approach to addressing addiction and the overdose epidemic.”

The office also distributes money and oversees the High Intensity Drug Trafficking Areas Program (HIDTA)—regional joint task forces involving federal, state and local police—and the Drug-Free Communities Program, which provides grants to prevent youth substance use.

What will Sara Carter of Fox News bring as the US's new 'drug czar'?

In recent years, Europe has seen early warning signs of an emerging synthetic opioid crisis. While heroin remains the primary opioid of concern, the rise of nitazenes—potent synthetic opioids with unpredictable effects—poses a growing threat. Unlike traditional opioids, nitazenes are often found in counterfeit medications or mixed with other substances, increasing the risk of overdose and complicating harm reduction efforts.

Correlation-European Harm Reduction Network

, is organising a webinar with leading European experts. The webinar will provide an evidence-based overview of the situation around nitazenes in Europe, examine emerging trends, and discuss which policy, healthcare, and harm reduction responses are needed to prepare.

Understanding Nitazenes: What are they, and why are they a growing concern?

Current Trends in Europe: Where are nitazenes being detected, and who is most at risk?

Health and Policy Responses: How can we prepare for and mitigate the risks?

Harm Reduction Strategies: What measures can effectively prevent overdose and support affected communities?

Drug Checking and Surveillance: How can early detection and monitoring systems help?

This interactive webinar will include expert presentations and case studies from different European countries, and a panel discussion to explore the most effective strategies for tackling nitazenes. Participants will have the opportunity to ask questions and share insights during the Q&A session.

Introduction – Tony Duffin (C-EHRN Chair)

European perspective – Joanna de Morais (EUDA)

Community Perspective – Leo Jefferys (EuroNPUD)

This webinar is crucial for harm reduction and healthcare professionals, policymakers, public health officials, and anyone involved in drug policy or healthcare. It will offer a comprehensive overview of current developments and trends related to nitazenes and explore practical responses at European, national, and local levels.

. Upon registration, you will receive a confirmation email with details on how to join the webinar.

Nitazenes in Europe – How should we prepare?

This blog post was originally published by the EAPC blog and is available here.

Screams of pain punctuate households worldwide, but disproportionately more so in low and middle income countries.

Our home witnessed this for two years as my adoptive mother was ravaged by cancer. She was finally administered pentazocine two days before she died. It barely made a dent on the pain emanating from a backbone broken by cancer. As she took her last breath, we exhaled in guilty, tearful relief.

Twenty three years later, my biological mother lay dying of interstitial lung disease and needed oral morphine to ease her breathlessness. Despite working for a WHO Collaborating Centre for Training and Policy on Access to Pain Relief, getting access to these pills in the most populated state in India was a nightmare. Ironically, the same state where the only government-run opium and alkaloids factory is located. A local doctor reluctantly prescribed oral morphine, which was then sent from Kerala – an approximate distance of 1952 kms.

Read more from Smriti Rana’s powerful piece for the EAPC (European Association for Palliative Care) Blog 

The influence of colonialism on the pain relief access abyss

With over $50 billion in settlement funds from opioid litigation becoming available over the next two decades, states, counties, and cities have a unique opportunity to invest in evidence-based interventions. In our newly released position paper, D4DPR highlights that Overdose Prevention Centers (OPCs)—a harm reduction approach that prevents overdose deaths, reduces the transmission of infectious diseases, and improves the quality of life for individuals who use drugs—represent a wise, cost-effective, and necessary use of these funds.

This position paper was conceptualized and written by D4DPR member Dr. Bruce Trigg. Dr. Trigg is a pediatrician who worked 23 years with the New Mexico Department of Health until his retirement in 2011. He is currently a clinician providing methadone and buprenorphine treatment for people with opioid use disorder.

Prioritizing opioid settlement funds for overdose prevention centers in the US

Join us for the Geneva Course on Drug Policy, Health, and Diplomacy from January 27-30, 2025! Co-organized by the Institute of Global Health, University of Geneva, the Global Health Center of the Geneva Graduate Institute, and the Global Commission on Drug Policy.

Participate in person in Geneva or online. Scholarships available!

Drug control, public health, harm reduction, and human rights

Current issues with cannabis, the opioid epidemic, and access to controlled medicines

Perspectives on drug policy reform in today's global diplomatic context

Join us and be part of the discussion! For more info and to apply, contact Kamila Guseinova at kamila.guseinova[@]unige.ch

Don’t miss this opportunity to engage with critical global drug policy issues!

Geneva course on drug policy, public health, and diplomacy

Dr Marianne Jauncey says NSW government must make ‘hard decisions’ to combat growing threat of synthetic opioids.

The head doctor at Sydney’s medically supervised injecting centre has compared the rise of synthetic opioids to a pandemic and says she is worried the government isn’t willing to make the “hard decisions” necessary to prepare for it.

Dr Marianne Jauncey began raising the alarm about the increasing prevalence of nitazenes earlier this year but was concerned the Minns Labor government had been reluctant to act because it “still feels for many like an emerging news story”.

She said that while New South Wales Health officials were “trying to take this seriously”, she was concerned about a lack of political will to take necessary measures to combat the threat, including by rolling out drug-checking services.

Australia: ‘People are dying’: Rise of nitazenes should be treated as pandemic, injecting centre head says

More than 100,000 overdose-related fatalities occur each year in the United States, so nobody doubts that the street drug supply is as lethal as ever.

But for the first time in decades, the US is seeing a sudden drop in drug overdose deaths, with surveys compiled by the Centers for Disease Control and Prevention showing a stunning 10.6% decline nationally this past year – an extraordinary shift following double-digit percentage increases during the pandemic.

They do not specify the causes, but if this trend holds, researchers from the University of North Carolina believe it could translate to 20,000 fewer overdose deaths per year.

To unpack the numbers, we turned to former New York City assistant health commissioner Dr. Daliah Heller, VP of Drug Use Initiatives at Vital Strategies, a global public health nonprofit organization.

Why drug overdose deaths in the US are dropping fast

The Taliban have launched a campaign against the country’s illegal narcotics industry, rounding up drug users, destroying opium poppy and cannabis fields, and arresting some traders. Driven by religious ideology, their initiative strikes at the backbone of Afghanistan’s informal economy and the livelihoods of the rural poor.

 The ban has drastically reduced cultivation, but Afghan-produced drugs are still hitting the global market as dealers continue selling stockpiles and some farmers resist the ban. The Taliban’s crackdown has devastated the economic outlook for farmers and rural labourers with few other employment options. Women have been particularly affected.

 The Taliban should be lenient with the poorest farmers as it implements the ban. The anti-drug initiative is in many foreign actors’ interest, creating opportunities for donors to support Afghanistan’s economic stabilisation. Licit crops will not offer sufficient employment, so the focus should be on job creation in non-farm industries.

Launched soon after they retook power in 2021, the Taliban’s campaign against narcotics has drastically reduced opium poppy cultivation and upended Afghanistan’s drug economy. Driven by ideology, the Taliban’s anti-drug efforts include rounding up drug users, eradicating crops, and shuttering drug bazaars. The Taliban’s enforcement impacts the livelihoods of millions of people, particularly poor labourers and rural women. Wealthy traders, meanwhile, are profiting from high prices by selling existing stocks. Many farmers have switched to crops such as wheat, but struggle with the reduced income. The ban’s future is uncertain; although the Taliban are adamant about implementing it, it could collapse under the weight of economic hardship. Foreign donors, who have much to gain from reduced drug production in Afghanistan, should harness the Taliban’s zeal for counter-narcotics and encourage licit economic growth. In the meantime, the Taliban should consider the welfare of the poorest farmers and implement a phased approach to the ban.

Implemented with growing seriousness, the Taliban’s anti-narcotics campaign has profoundly affected a country that ranks among the world’s largest suppliers of illegal drugs. The main focus has been opium, a central part of Afghanistan’s agricultural sector. Enforcement began slowly, but has grown stricter. Taliban forces started with easy targets, herding drug users into jails and rehabilitation centres. They then warned farmers not to cultivate the opium poppies whose resin they have harvested for centuries. When that failed, the Taliban deployed fighters to face down villagers and destroy their crops. As a result, the UN estimates, cultivation declined by 95 per cent – more than any other counter-narcotics campaign in recent history. The Taliban also started to apply pressure on traffickers, despite the fact that some of them backed their movement for decades. More recently the de facto authorities shut down drug bazaars and arrested hundreds of dealers.

Opium & opioids

Same fight, new arena: Mobilising expertise in times of regression

INCB recommends increased morphine production for palliative care

Canada: Everything you need to know about B.C.'s toxic drug crisis

Canada: Everything you need to know about B.C.'s toxic drug crisis

What will Sara Carter of Fox News bring as the US's new 'drug czar'?

Nitazenes in Europe – How should we prepare?

The influence of colonialism on the pain relief access abyss

Prioritizing opioid settlement funds for overdose prevention centers in the US

Geneva course on drug policy, public health, and diplomacy

Australia: ‘People are dying’: Rise of nitazenes should be treated as pandemic, injecting centre head says

Why drug overdose deaths in the US are dropping fast

Trouble in Afghanistan’s opium fields: The Taliban's war on drugs